[SOLVED] database Slide 1

Slide 1

CDS Governance Guideline Project

Researcher: Junbin Sun
MentorSameer Malhotra

Presentation

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Background
Clinical Decision Support rules are increasingly being used in EHR.
It is challenging to keep track of the latest evidence and implement CDS rules based on guidelines which vary by specialty, institution and national medical societies.
Representation of Physicians on CDS governance and Patient safety committees is not uniform or adequate to keep the implemented guidelines up to date.
Significant time lag between available new evidence and its implementation
April 8th, 2016
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Motivation
Develop a tool to assist with CDS governance
Make the process more democratic, seeking input from a wider Physician audience (not limited to committees)
Utilize desktop as well as mobile platforms
Analyze the impact of the tool:
Through focus groups (Qualitative)
Following the life cycle of a new guideline and revision of existing guideline utilizing the tool
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Related Health Policy and Regulation
Most clinical decision support (CDS) functionalities can be categorized as health management health IT.
FDASIA Risk-based regulatory framework pertaining to health information technology.
Types of risk that may be posed by health IT that impact patient safety, the likelihood that these risks will be realized, and the impact of these considerations on a risk-based approach;
Factors or approaches that could be included in a risk-based regulatory approach for health IT to promote innovation and protect patient safety
Approaches to avoid duplicative or overlapping regulatory requirements.

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Source: Slight, Sarah P., and David W. Bates. A risk-based regulatory framework for health IT: recommendations of the FDASIA working group.Journal of the American Medical Informatics Association21.e2 (2014): e181-e184.

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Framework for risk and innovation dimensions of assessing risk by patient harm

Source: Food and Drug Administration. Health information technologies: administration perspectives on innovation and regulation. (2013).

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Distribution, presentation and implementation of guidelines

Dissemination: communication of information to care providers to increase their knowledge and skills.
Implementation :the introduction of an innovation into daily routines.
Grimshaw et al suggested that educational materials may have a modest effect on guideline implementation that may be short-lived
Source: Davis D, Tailor-Vaisey A. Translating guidelines into practice: a systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines.CMAJ1997; 157: 408-416
Grimshaw JM, Thomas RE, MacLennan G, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies.Health Technol Assess2004. In press.
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How to communicate more efficiently?
Website Based
Mobile application
Design of the data schema
Structured guideline information
User preference guideline collection
Categorized information

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Data Schemas

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Database Schema
CDS guideline are structured. Guidelines for different specialties are easier to retrieve for research or clinical practice.
CDS guideline can be updated through internal application that offer convenient access to physicians and committee members.
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General Guideline List
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Guideline Categorized Structure

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Guideline Categorized Structure

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Guideline Categorized Structure

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User interface setup

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Evaluation
1. App usage, weekly website visit, active user in discussing forum.

2. Completion of development
3. Focus groups with previous participants
4. Refinement based on feedback

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Reference
Slight, Sarah P., and David W. Bates. A risk-based regulatory framework for health IT: recommendations of the FDASIA working group.Journal of the American Medical Informatics Association21.e2 (2014): e181-e184.
Food and Drug Administration. Health information technologies: administration perspectives on innovation and regulation. (2013).
Davis D, Tailor-Vaisey A. Translating guidelines into practice: a systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines.CMAJ1997; 157: 408-416.
Montgomery, Alan A., et al. Evaluation of computer based clinical decision support system and risk chart for management of hypertension in primary care: randomised controlled trial.Bmj320.7236 (2000): 686-690.
Grimshaw JM, Thomas RE, MacLennan G, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies.Health Technol Assess2004. In press.

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Question & Answer

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